MRC Centre of Epidemiology for Child Health, UCL-Institute of Child Health, London, UK.
Arch Dis Child. 2011 Mar;96(3):270-5. doi: 10.1136/adc.2010.190314. Epub 2011 Jan 17.
To determine antecedent patterns of healthcare use by children fatally or seriously harmed by maltreatment.
The authors analysed recorded healthcare use for children who were the subject of a serious case review (SCR) in England in 2005-2007. The SCRs were initiated when a child under 18 years old died or was seriously harmed, maltreatment (abuse or neglect) was a factor, and there were lessons for interagency working. The authors analysed a purposive sample (N=40), similar in key demographics to all 189 SCRs in England in 2005-2007.
Children had extensive recorded contact with universal (N=34/40; 85%) and secondary (N=26/40; 65%) healthcare services and children's social care (N=21/40; 53%). Thirty-one children (78%) had recorded health visitor and/or school nurse contact. Fourteen children (35%) had missed appointments. Almost three-quarters (N=29) had complex family problems recorded (parental domestic violence, alcohol/drug and/or mental health problems). Data quality regarding healthcare use was poor, and the extent and type of 'missing data' varied by age.
Complex paediatric and family problems and a high level of contact with services preceded serious adverse events. Universal health services are likely to be well placed for giving ongoing and family-orientated support to vulnerable families. The absence of standardised data collection and any control group limits how far the Biennial Analyses of SCRs can meet their stated objective of identifying national trends and patterns. Linking SCRs to healthcare databases would provide a control group, improve understanding of the population context and diminish demands for data from professionals delivering care.
确定因虐待而致死或受重伤的儿童之前的医疗保健使用模式。
作者分析了英格兰 2005-2007 年严重案件审查（SCR）中受虐待（虐待或忽视）影响的儿童的记录医疗保健使用情况。当 18 岁以下的儿童死亡或受重伤，虐待是一个因素，并且对机构间合作有经验教训时，就会启动 SCR。作者分析了一个有目的的样本（N=40），在关键人口统计学方面与英格兰 2005-2007 年的所有 189 例 SCR 相似。
儿童与普遍（N=34/40；85%）和二级（N=26/40；65%）医疗保健服务以及儿童社会护理（N=21/40；53%）有广泛的记录接触。31 名儿童（78%）有记录的保健访客和/或学校护士接触。14 名儿童（35%）错过了预约。近四分之三（N=29）记录了复杂的家庭问题（父母家庭暴力、酒精/药物和/或心理健康问题）。关于医疗保健使用的数据质量较差，并且“缺失数据”的程度和类型因年龄而异。
复杂的儿科和家庭问题以及与服务的高度接触是严重不良事件的前兆。普遍的卫生服务可能非常适合为弱势家庭提供持续的、以家庭为导向的支持。缺乏标准化的数据收集和任何对照组限制了 Biennial Analyses of SCRs 能够在多大程度上实现其确定国家趋势和模式的既定目标。将 SCR 与医疗保健数据库链接将提供一个对照组，提高对人群背景的理解，并减少对提供护理的专业人员的数据要求。
